Surgical treatment of pathological femoral neck fracture ending in push-through total femoral endoprosthesis. A case report

Arthroplasty in managing tumors of the extremities is a challenging surgery. Careful planning and the expertise of the surgical team are of utmost importance, especially when managing unpredictable intraoperative complications. In this study, we report on the surgical management of a pathological femoral neck fracture with multiple metastases with carcinoma of an unknown primary origin. Primary total hip replacement was planned. However, due to the presence of multiple metastases in the lower limb with intraoperative fracture of the distal femur, a total femoral replacement with a push-through endoprosthesis was carried out primarily. The duration for the surgical intervention was three hours and 56 minutes. Following surgery, initial intensive care was necessary due to the multimorbidity of the patient. Two days after surgery, the patient could be mobilized with full weight bearing and no restriction of range of motion of the entire left lower limb supervised by physiotherapists at ward level, which she tolerated well. The pain was significantly relieved during hospital stay. Mega-endoprostheses with push-through stems are a reliable option in cases with multiple metastases.